MEDICARE: AMY KAY JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-19-39406	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053828970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY KAY JOHNSON

Provider Business Mailing Address
First Line	:	7107 S YALE AVE # 161
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6308
Country	:	US
Telephone Number	:	918-280-0090
Fax Number	:	918-561-6764

Provider Business Practice Location Address
First Line	:	7107 S YALE AVE # 161
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6308
Country	:	US
Telephone Number	:	918-280-0090
Fax Number	:	918-561-6764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2017
Last Update Date	:	09/02/2021

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